Utility of microscope-integrated optical coherence tomography (MIOCT) in the treatment of myopic macular hole retinal detachment

Abstract

Macular hole-associated retinal detachment in high myopia is described as a final stage in progression of myopic traction maculopathy (MTM).^1â€"3 Shimada et al⁴ described the progressive stages of MTM from macular retinoschisis to serous retinal detachment in high myopia. Stage 4 MTM is characterised as disappearance of retinoschisis with progression to retinal detachment due to macular hole formation. It is hypothesised that vitreoschisis and abnormal vitreo-retinal interface create the premacular tangential traction.^{5 6} Intraoperative triamcinolone acetonide is used to visualise the residual posterior vitreous cortex (PVC). We hereby describe the utility of microscope-integrated optical coherence tomography (MIOCT) in assisting complete removal of PVC and internal limiting membrane (ILM) peeling with multilayered inverted ILM flap in the treatment of myopic macular hole retinal detachment. MIOCT helped identify vitreoschisis and confirm the position of ILM flaps over the macular hole intraoperatively.

Keywords: macula; ophthalmology; retina.

Figure 1

Preoperative swept-source optical coherence tomography of the right eye showing a full-thickness macular hole of 432 µ horizontal diameter with macular detachment. A fine layer of vitreous cortex referring to the posterior hyaloid is also visualised bridging over the macular hole (white arrow).

Figure 2

Intraoperative microscope-integrated optical coherence tomography image after posterior vitreous detachment induction, showing vitreoretinal traction at the edge of the macular hole, suggestive of an intact layer of posterior vitreous cortex, which is well identified by triamcinolone acetonide crystals.

Figure 3

Intraoperative microscope-integrated optical coherence tomography grab showing sudden release of traction at the macular hole edges after the posterior hyaloid is peeled off from the macula.

Figure 4

Intraoperative image of microscope-integrated intraoperative optical coherence tomography (MIOCT) grab after inverted internal limiting membrane (ILM) flap technique, facilitating macular hole closure with ILM flaps visible into the macular hole (yellow asterisk). The position of flaps is confirmed in real time via MIOCT.

Figure 5

Postoperative swept-source optical coherence tomography of the right eye showing closure of macular hole with reattachment of neurosensory retina.